Provider Demographics
NPI:1144948464
Name:MSRC ONE, LLC
Entity type:Organization
Organization Name:MSRC ONE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DEHORTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-617-5531
Mailing Address - Street 1:1435 HIGHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-2516
Mailing Address - Country:US
Mailing Address - Phone:443-617-5531
Mailing Address - Fax:
Practice Address - Street 1:17470 FRALEY BLVD
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-2227
Practice Address - Country:US
Practice Address - Phone:571-774-9910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility